Is the Best Treatment for Early Breast Cancer No Treatment?
If you're diagnosed with breast cancer, you have surgery and get rid of it. Right? Not quite. For some women with early-stage breast cancer, a watch-and-wait approach, highlighted in the video above by Time, may be a better option.
Ductal carcinoma in situ (DCIS) is considered to be "stage 0" breast cancer; it involves an abnormal growth that's confined to a milk duct (as opposed to invasive cancer, which spreads to other parts of the breast or beyond). These days, DCIS accounts for as many as a quarter of all cancers found via mammography.
It may also be massively overtreated, experts say. While women with DCIS commonly opt for surgery, some even going so far as to get a double mastectomy (as Sandra Lee did earlier this year after her own DCIS diagnosis), the latest research suggests that many cases of DCIS will never progress to invasive cancer and become life-threatening.
In June, a team of researchers from Brigham and Women's Hospital and Dana-Farber/Brigham and Women's Cancer Center in Boston reported that surgery doesn't improve survival rates for women with low-grade DCIS. And a study published in August in JAMA Oncology found that women diagnosed with DCIS have the same risk of eventually dying of breast cancer as women in the general population—and aggressive treatment doesn't improve the odds.
Unfortunately, doctors don't yet have the ability to tell which lesions will grow and spread and which won't. That means that all cancers tend to be treated aggressively, with many women getting perhaps unnecessary mastectomies.
“We are talking about major surgery,” Shelley Hwang, MD, chief of breast surgery at Duke University and Duke Cancer Institute in North Carolina, told Time. “It can involve revisions, prolonged pain, hernias. I think the best way to understand it is that it may require surgeries for the rest of your life. Some small, some major. But it’s not like you’re done and you can forget about it. It just doesn’t work that way.”
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The alternative: active surveillance, or watchful waiting, in which patients opt out of the standard surgery/chemotherapy/radiation protocol (and the side effects and toxicities that go along with it) and instead are closely monitored by doctors. There are currently large studies underway in both the U.S. and the United Kingdom to see if active surveillance works and which patients are the best candidates.
With all the arguments over breast cancer screening in recent years, it's easy to lose sight of the fact that finding cancer is only the first step. “It’s not the ‘finding more’ that we need to work on," Dr. Hwang told Time. "It’s what are we going to do with the more that we find?”
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